Psychology & Neuroscience
Schizophrenia Doesn’t Mean You Have a Split Personality
A deep dive into what schizophrenia is, what it isn’t, and myths about what it’s like to live with schizophrenia.
Maybe you’re like me: I grew up watching crime shows, like Law and Order SVU, that linked mental illness and violence. For most of my life, I believed these shows got it right. I thought that if someone was diagnosed with something like schizophrenia, then violent behavior was a guarantee.
As I completed a degree in psychology, this belief began to erode. I learned of the untruth that mental illness = violence.
Efforts to have honest discussions about mental health are far-reaching, which means that you may already know this untruth.
So, why should you keep reading?
Despite strides to reduce the stigma surrounding mental illness, public perceptions of schizophrenia remain unfairly hostile.
Schizophrenia affects millions worldwide, which makes it essential to know what it is, what it isn’t, and how myths about schizophrenia may impact your family, friends, and neighbors.
Please note: I am not a licensed psychologist or psychiatrist, and the information in this article should not be viewed as medical advice. Claims are based on empirical research, not personal experience with schizophrenia. No research will describe the experiences of every person with schizophrenia, and I’m not making prescriptive claims about individual situations.
What Is Schizophrenia?
Defined by The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), schizophrenia impairs social, occupational, and personal function due to altered perceptions, delusions, odd thoughts, abnormal movements, and emotional disturbances.
Symptoms
Researchers have categorized the symptoms of schizophrenia into four groups: positive symptoms, negative symptoms, motor symptoms, and cognitive symptoms.
Concerning schizophrenia, positive and negative symptoms do not mean “good” or “bad”. Instead, think of positive and negative symptoms as thoughts or behaviors that are added or removed, respectively.
Positive symptoms are additions to a person’s behavior, thoughts, or emotions. Some common positive symptoms are 1) delusions, strongly held beliefs despite contradictory evidence, 2) hallucinations, perceiving sounds, visuals, or sensations without external stimuli, 3) disorganized thought and speech — the inability to think logically or form coherent sentences, and 4) inappropriate affect, which describes unusual emotional responses such as smiling after learning a relative died.
Negative symptoms are traits that a person seems to be lacking. Common negative symptoms include 1) flat affect, which is characterized by a lack of emotional expression, 2) alogia, a reduction in speech, 3) avolition, losing the motivation to pursue goals, 4) social withdrawal, or not participating in social interactions, and 5) anhedonia, which is a lack of pleasure or enjoyment.
Motor symptoms are related to physical movement and can include 1) catatonia, which is a pattern of movements like maintaining a rigid posture or waving limbs for hours at a time, 2) psychomotor slowing, which describes stiff, slow, or effortful movement, and 3) diminished facial expressions, which can include grimaces or other odd facial expressions.
Cognitive symptoms include difficulties with recalling memories, paying attention, making decisions, or using new information.
This list is not exhaustive, and each individual will display different symptoms, with varying levels of severity, in different parts of their lives.
Prevalence
Schizophrenia affects 1% of the population, which translates into millions worldwide.
Symptoms begin to appear in late teens or early twenties: age 23 for men and 28 for women, on average. Onset is uncommon later in life.
Although schizophrenia is prevalent in all socioeconomic groups, it seems to occur more frequently in lower socioeconomic groups. Sareen et al. (2011) offered two possible explanations:
- Lower socioeconomic status is related to adversity and stress, which can increase the risk of developing schizophrenia.
- Due to hospitalization expenses, loss of work, or genetic factors, schizophrenia can lead people to fall from a higher to a lower socioeconomic level.
It was long thought that there were no gender differences in schizophrenia prevalence, but some recent research suggests that relying on more specific diagnostic criteria scrutinizes the validity of this claim. Also, there is evidence that gender differences exist for the age of onset, symptoms, and treatment efficacy.
Finally, schizophrenia is related to increased suicide risk.
Phases
Research suggests that schizophrenia has three phases:
- In the prodromal phase, mild symptoms may begin to appear, and it is clear that some degree of deterioration is occurring. For instance, a person stop engaging in social interactions.
- Next is the active stage, which is when the symptoms discussed above appear. The active stage may be prompted by stress or trauma.
- Following the active stage, many people enter the residual stage, where they return to prodromal-like function.
These stages don’t occupy a set time period — each stage could last for days, months, or years. Furthermore, it is not a guarantee that each individual will cycle through all three stages.
Causes & Risk Factors
Empirical research doesn’t point to a singular cause, rather, the interaction of biological, psychological, social, and environmental factors contribute to the onset of schizophrenia.
The list of potential causes is lengthy, so let’s split the discussion into biological (related to neurochemistry, brain changes, and genes) and non-biological (related to stress, interpersonal relationships, and living situations) explanations.
Biological Explanations:
One of the most well-known biological explanations for schizophrenia is the dopamine hypothesis, the idea that schizophrenia is caused by excessive dopamine. The dopamine hypothesis arose out of the discovery that early antipsychotics, drugs that treat schizophrenia, acted on dopamine receptors. Similar explorations into other drugs led to the glutamate hypothesis: schizophrenia is caused by an underactivation of glutamate receptors.
In addition to neurochemistry, researchers have looked into brain changes that are related to schizophrenia. Anatomical differences have been found. For instance, researchers have found that schizophrenia is related to 1) enlarged ventricles, which can impact surrounding brain structures, and 2) decreased frontal lobe activity, which is related to emotions, memory, problem-solving, and language.
To conclude our discussion of biological explanations, let’s take a look at genetic factors. Researchers have found that schizophrenia is more common among genetic relatives — the more closely related, the higher the risk. This is further supported by twin studies, which have found that identical twins are more likely to be diagnosed with schizophrenia, as compared to fraternal twins and non-twin siblings. More recent studies have pointed to genes that may contribute to schizophrenia.
Biology alone is not enough to explain schizophrenia; we must also examine psychological, social, and environmental factors.
Non-Biological Explanations:
Stress is related to schizophrenia. Stressful events may lead to the development of symptoms or an initial episode of psychosis––losing touch with reality. Also, stress can impact what it’s like to live with schizophrenia: there is evidence that stress is related to the severity of symptoms.
In the video below, Aisha, who was diagnosed with schizophrenia, describes how stress impacts her life.
Besides stress, schizophrenia has been linked to interpersonal relationships. In particular, emotionally charged family relationships are related to schizophrenia: researchers highlight the importance of caregiver attitudes and how emotions are expressed.
Finally, some environmental or cultural factors are related to schizophrenia. Research suggests that the severity of symptoms, percentage of the population diagnosed, and treatment efficacy differs across racial groups.
Treatment
The history of schizophrenia treatment is befouled with the failures of institutionalized care — for much of the 19th and early 20th centuries, patients in psychiatric hospitals were neglected and treated inhumanely.
In the 1950s, treatment for schizophrenia was revolutionized with the discovery of antipsychotic drugs.
Today, it is widely accepted that schizophrenia is treatable with a combination of drugs, therapy, and community approaches.
Let’s take a look at each one individually.
Drugs: Antipsychotic drugs are effective at reducing the symptoms of schizophrenia. In a meta-analysis, a type of study designed to explore the results of dozens or hundreds of other studies, researchers found that antipsychotics are more effective than a placebo at improving symptoms. Some studies suggest that antipsychotics are more effective at treating positive symptoms than negative symptoms.
Therapy: In addition to drugs, some research suggests that therapy is an effective treatment of schizophrenia. In particular, cognitive-behavioral therapy (CBT) has strong empirical backing. For schizophrenia, CBT can help individuals interpret and accurately evaluate hallucinations, understand what causes schizophrenia, notice events that trigger symptoms, and cope with uncomfortable thoughts. Similar to drugs, CBT seems to be more effective at targeting positive symptoms rather than negative symptoms.
Community Approaches: Mental health centers, supervised residences, employment providers, and education make up community approaches. The goal is to create an environment in which people with schizophrenia can live independent, respectable, and stimulating lives. Some community mental health centers focus on providing educational information. In a study, community health center members with schizophrenia were taught mindfulness techniques, which reduced self-perceived negative stigma.
Alternative Diagnoses
In the DSM-5, there are diagnoses that are similar to schizophrenia. Together, these disorders are referred to as schizophrenia spectrum disorders.
Here are some examples:
- Schizotypal personality disorder is characterized by strange thought patterns, few close relationships, odd beliefs, and eccentric behavior.
- Brief psychotic disorder is similar to schizophrenia, except delusions, hallucinations, and disorganized speech/behavior last for less than 1 month.
- Schizoaffective disorder is a combination of schizophrenia and a mood disorder, such as depression or bipolar disorder.
7 Myths About Schizophrenia
Now that we have explored empirical research on schizophrenia, let’s look at 7 common myths:
- Schizophrenia causes violence. Although some research suggests that there is a relationship between schizophrenia and violence, it seems to be due to substance abuse or other comorbidities, rather than schizophrenia itself.
- It makes it impossible to hold a job. Elyn Saks, a law professor, is an example of the opposite: it is possible to be employed in prestigious positions while managing the symptoms of schizophrenia.
- It means you have a split personality. This myth confuses schizophrenia with dissociative identity disorder (DID). Having schizophrenia does not mean you have a split personality, nor does it mean you have “multiple personality disorder”, which is now called DID.
- Schizophrenia is untreatable. As highlighted above, schizophrenia can be treated with a combination of drugs, therapy, and community approaches.
- Schizophrenia requires long-term hospitalization. Community centers and group homes have been shown to help people with schizophrenia, sometimes more so than hospitalization. Although, community centers may not be necessary: living at home is possible, and sometimes preferable.
- You’ll have intense mood swings. Bipolar disorder, not schizophrenia, is characterized by mood swings, or more specifically, cycling between manic and depressive episodes. Symptoms can also include rapid fluctuations in emotional states, energy level, and attention, which are not typical of schizophrenia.
- Schizophrenia is the result of bad parenting or negative childhood experiences. Although early traumatic experiences may be a causal factor, evidence suggests that a combination of biological and non-biological factors contributes to schizophrenia.
In Sum
In this article, we’ve explored the symptoms, causes, and treatments of schizophrenia.
Despite efforts to destigmatize mental illness, people continue to display a strong aversion to schizophrenia.
I hope this article highlights the importance of treating those with schizophrenia with empathy, understanding, and kindness.
